Not So Good at Preventing Premature Death

Dying before your time is bad enough. Dying from something like heart disease, diabetes, treatable cancer, or a bacterial infection that never should have killed you is worse. Yet a new study finds that the United States ranks last among industrialized countries when it comes to such preventable deaths and that our performance actually got worse instead of better over a five-year period.

The study examined preventable deaths before age 75 in 19 industrialized countries in 2002-2003 and compared them with preventable deaths five years earlier. Death was considered preventable if it shouldn't have occurred with timely and effective healthcare. The study, which was conducted by researchers at the London School of Hygiene and Tropical Medicine and published in the January/February issue of the journal Health Affairs, put the United States in last place in 2002-2003, with 109 deaths per 100,000 people, down from 15th place in 1997-1998. If the United States were able to match top-performing France, Japan, and Australia, 101,000 fewer people would die annually, the study found.

Two big factors contribute to the country's poor showing: the 47 million people lacking health insurance and the high cost of healthcare even for many who have coverage. "We are the only country in the study that doesn't have insurance for the whole population," says Cathy Schoen, a senior vice president at the Commonwealth Fund, a healthcare think tank that funded the study. In addition, high cost-sharing can lead people to delay getting necessary care, she says. "Other countries don't have that barrier."

Schoen notes that countries with universal health coverage can take a systematic approach to improving standards of care. Both the United Kingdom and France have zeroed in on improving heart disease and cancer treatment, for example, identifying best practices by providers and encouraging their adoption nationwide. And thanks to wide use of electronic medical records there, it's far easier to ensure that people with chronic conditions get the ongoing care that they need, she says.

Implementing electronic medical records, like any healthcare advance, is more complicated in the United States because our private healthcare system is so fragmented. But "if there's a collective will, we could do it," says Schoen, who sees the move as an ounce of prevention.